Individual
DR. NATHANAEL BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
3208 N ACADEMY BLVD STE 140, COLORADO SPRINGS, CO 80917-5111
(719) 301-5300
(719) 301-5303
Mailing address
3208 N ACADEMY BLVD STE 140, COLORADO SPRINGS, CO 80917-5111
(719) 301-5300
(719) 301-5303
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00202572
CO
Other
Enumeration date
08/18/2015
Last updated
08/18/2015
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